What causes an incisional hernia?
An incisional hernia is one that forms in a previous incision from prior surgery. The incidence of a hernia forming in a previous abdominal scar is about 20%, and is even higher in people who are obese or who are active smokers. The hernia defect itself can form anywhere along the scar tissue of a previous incision, and can be very small to large and complex. Incisional hernias can develop slowly over many or can even occur years after surgery. The underlying cause is usually due to inadequate healing or excessive pressure on the abdominal wall scar.
Who is at risk for incisional hernias?
Conditions that increase strain on the abdominal wall such as obesity, pregnancy, peritoneal dialysis, liver disease, chronic straining/lifting, chronic cough, or chronic difficulties with bowel movements or urination are risk factors for hernia formation. Also smoking, advanced age, malnutrition, poor metabolism, steroid medications, chemotherapy, and hematoma or infection after a prior surgery put a patient at a higher risk of developing an incisional hernia.
What are the symptoms?
Pain is usually the first symptom a person will have with an incisional hernia, regardless of whether or not they have a bulge at the incision site or the abdomen. Once the bulge is present, it can increase in size and gradually cause more symptoms such as nausea and vomiting. If internal organs such as intestine becomes entrapped in the hernia defect, this can be life-threatening if left undiagnosed and untreated.
How is an incisional hernia treated?
The surgical repair of an incisional hernia is largely dependent on reducing or eliminating the tension present at the surgical site. The method that is preferred by most hernia surgeons is a tension-free method and is used by most medical centers. This procedure involves the placement of a mesh patch. Once the mesh is sewn into the area, it bridges the weakened area that is beneath it. The mesh becomes firmly integrated into the abdominal wall as the area heals, and continues to protect the organs of the abdomen.
How is incisional hernia repair performed?
The procedure can be done in two different ways, either by a laparoscopic approach or by a conventional open repair. In a laparoscopic incisional herniorrhaphy, small incisions are made and a tube-like camera and instruments are used to place the mesh. In the conventional open repair procedure, the hernia is accessed through a larger abdominal incision. If intestines are trapped in the hernia (incarcerated), or if they have become twisted off from their blood supply (strangulated) this often requires part of the intestine to be removed with the remaining ends reconnected (resection and anastomosis). The approach to repair depends on many factors, and operative planning often requires preoperative imaging such as CT scan. The surgeons at Advanced Surgical and Bariatrics of NJ will meet with you to discuss your best options. The main advantage of laparoscopic incisional hernia repair is reduced risk of mesh infection.